Chapter 6. Psychosocial Stressors,Psychiatric Diagnoses and Utilization of Mental Health Services Among Undocumented Immigrant Latinos

Abstract

The combined effects of minority status, specific ethnic group experiences (political, economic, trauma and immigration history), poverty, and illegal status pose a set of unique psychiatric risks for undocumented Latinos in the United States. Restrictive legislation and policy measures have limited access to health care, and other basic human services to undocumented immigrants and their children throughout the nation. However, little is known about the patterns of mental health care use, psychiatric diagnoses and psychosocial problems prevalent among the undocumented who do succeed in presenting to clinical settings and to the mental health sector. To begin to address the need for further understanding in this area, we completed a clinical chart review of 197 outpatient adult psychiatric charts in a Latino mental health outpatient treatment program located in an urban hospital system.

We compared the diagnoses and mental health care use of undocumented Latino immigrants (15%) with that of documented (73%) and US born Latinos (12%) treated in this clinical setting. The undocumented Latinos in our study were more likely to have a diagnosis of anxiety, adjustment and alcohol abuse disorders. The undocumented also had a significantly greater mean number of concurrent psychosocial stressors (mean number = 5, p < .001) ascompared to documented immigrants and US born groups, which both had a mean number of 3 stressors identified at evaluation. The undocumented were more likely to have psychosocial problems related to occupation, access to healthcare and the legal system. However, the undocumented had a lower mean number of total mental health appointments attended (mean visits = 4.3, p < .001) in which to address these stressors as compared to documented immigrants (mean visits = 7.9) and US born (mean visits = 13.3). In terms of other previous mental health service use, the undocumented group had lower rates of lifetime inpatient and outpatient treatment use.

The results of this study suggest the importance of early assessment of psychosocial stressors, substance use and barriers to care when treating undocumented immigrants. Although all Latino groups included in this investigation demonstrated numerable concurrent stressors, our investigation highlights the particular importance of accessible social services and supports for addressing psychosocial stressors in the lives of undocumented patients. Our results stress the importance of reexamining policies, that restrict access to social services and healthcare for the undocumented. Our results also suggest the importance of culturally appropriate evaluation and treatment of substance abuse disorders as well as addressing other psychological and behavioral responses to multiple stressors among undocumented individuals.     

Mexican Immigrants

Abstract

Social Work's history is embedded in this profession's service and commitment to immigrant populations. This new century presents itself with a new mixture of immigrants who come to United States (U.S.) shores seeking a better life. The challenge to social workers is to be well-versed in social policy, human behavior, and practice realms related to serving these immigrants. Schools of social work must insure that curriculum reflects the needs and situations of this new mix of immigrants. One of the largest groups in this mix are those immigrants from Mexico. Of particular concern is the adaptation of Mexican and other Latino immigrants who come to this country without documentation. Social workers have an ethical responsibility to serve these clients in a culturally competent and informed manner. They must keep updated on immigration policy and entitlement or eligibility issues that mitigate these immigrants' ability to survive.     

Mental Health Intervention with Hispanic Immigrants

Abstract

The underutilization of mental health services by Hispanic immigrants has been well documented in the literature. Hispanic immigrants encounter numerous obstacles which prevent them from successfully navigating through the mental health system. This reality is further compounded by the fact that research appears to suggest an increased rate of mental health disorders among Hispanics. This article underscores the importance of understanding the influence of a Hispanic client's worldview, language, and religion on the provision of mental health services. A case vignette is presented as a means of illustrating key conceptual points. Practice principles or conclusions drawn from this article should be used as a general guide by mental health practitioners.     

Surviving Chernobyl in America

Abstract

This paper fills an informational gap for multidisciplinary providers of services to the former Soviet Union (FSU) immigrants in the United States, highlighting the long-term medical and mental health consequences of this group's pre-migration exposure to the 1986 Chernobyl nuclear disaster. The international literature is selectively presented together with recent findings of Chernobyl mental health sequelae in a cohort residing in the United States. Guidelines for service providers, as well as Russian language health service resources in US cities populated by significant FSU communities, are also furnished.     

Chapter 3. Mental Health Care of Hispanic Immigrant Children

Abstract

This chapter addresses the mental health care of Hispanic immigrant children within a school-based context. The school system is presented as a natural support agent that is psychologically, culturally and geographically accessible for the delivery of culturally competent mental health services. The development of a multifaceted New York City public school-based program created, by the first author of this chapter, in response to the psychosocial needs of Hispanic immigrant children is discussed as a viable approach that may be used in the provision of ethnic-sensitive mental health care.     

Chapter 2. Mental Health in the Hispanic Immigrant Community

Abstract

This chapter addresses the mental health status of Hispanics in the United States. The prevalence and incidence of mental health disorders among different Hispanic ethnic subgroups is examined. Patterns of mental health services utilization and barriers to mental health care are also reviewed. Research specific to best mental health practices with Hispanics is stressed.     

New Hispanic Migration and HIV Risk in New York

Abstract

This paper reports on research designed to assess access to care by Latino immigrant populations in the New York area. A qualitative approach and methods were employed, involving focus groups with PWAs and affected men and women from Mexico, the Dominican Republic and Central America to explore the perceptions, beliefs, experience and knowledge of HIV care issues and the issues affecting health-seeking behavior. Among the data collected to provide context, depth and detail to the issue of access and utilization of services, was the detailed information on migration and HIV risk reported here.

A total of 57 men and women participated, ranging in age from 19-61. Results included information on migration patterns, obstacles for Latino immigrants living in the U.S., social networks, community resources, knowledge of HIV/AIDS, risk behavior and access to information. Data support the conclusion that to be effective in reaching and providing services to these immigrant groups, it is crucial to understand the environment from which they come and the impact of immigration. Poverty; repressive governments; lack of education/literacy; ethnicity, class; color-based stigma; and cultural norms are crucial factors in determining their attitudes, motivations, decisions and behavior. The key elements for the provision of services to this population appear to be those which build on cultural norms and which network human and institutional resources.     

Working with Caribbean Immigrants After the World Trade Center Tragedy

SUMMARY

Caribbean immigrants were among those transfixed by the destruction and human suffering caused by the World Trade Center tragedy. An emergent cliché is that life will never be the same after September 11th. This study explores the issues that impact the health and well-being of English-speaking Caribbean immigrants and challenges social workers to reassess their intervention with immigrant populations in the Post 9/11 era.     

Understanding Immigration and Psychological Development

Abstract

Approximately one in five children in the U.S. are born to immigrant families in which at least one parent is foreign-born. Existing theoretical frameworks suggest that immigration experiences can increase acculturative stress and lead to developmental psycholopathology in immigrant children. These models, however, do not account for levels in the environment that trigger this stress and/or serve as forms of resilience. Drawing from Bronfenbrenner's multilevel, bioecological model of development, this paper presents a framework that charts environmental processes which generate or buffer acculturative stress and, therefore, mediate the impact of immigration on psychological well-being. Empirical research shows that Mexican immigrants, on the whole, fare better than U.S.-born groups in terms of mental health outcomes. These results are explained in the context of the presented theoretical model. Though further research is needed, preliminary evidence suggests that encouraging “enculturation,” as opposed to “acculturation,” has positive mental health repercussions for Mexican American children. Further research using the presented theoretical framework as well as policies and practices that incorporate and leverage the cultural strengths of Mexican immigrant children should be pursued.     

Integrating Behavioral Health Care and Primary Care: Application of a Clinical and Economic Model in Culturally Diverse Communities

Although mental illness treatment protocols exist, the organization and financing of screening and treatment services inhibit access. These challenges are compounded for refugees, immigrants, and other groups vulnerable due to their ethnicity, race, or culture. By creating a system-wide, collaborative, integrated model that recognizes and addresses critical clinical and economic aspects in the delivery of services, high quality, evidence-based care can be made available to groups susceptible to the burdens of mental illness. Clinically and financially aligning primary and specialty care offers a viable alternative for improving access and quality of mental health services to vulnerable populations.     

Immigration and the Remaking of New York

Abstract

The 1965 Immigration and Nationality Act abolished quotas that favored European immigrants, and for the first time placed all countries on an equal footing. The law resulted in increased overall immigration, and altered the sources of immigrants to the U.S. Since 1970, New York City has absorbed 2.6 million immigrants, primarily from non-European sources, who have dramatically altered the City's racial/Hispanic mix. Using immigration and birth records, as well as data from decennial censuses, this paper examines immigration to New York and assesses the demographic impact of these flows on the City's population.

Current immigrant flows have noticeably increased the ethnic diversity within the major race/Hispanic groups. This is largely due to increases in refugee flows, and to recent changes in immigration law that allow for “diversity” visas, which are aimed at countries that are under-represented in immigration flows to the U.S. Diversity immigration has provided New York with a continuing flow of new groups, most recently from Bangladesh, Mexico, Ghana, Nigeria, and Senegal, who have established enclaves in many of the City's neighborhoods. The increasing diversity poses serious challenges for social service and health care professionals, who need to devise new strategies to deal with the disparate socioeconomic backgrounds, cultures, and belief systems of new ethnic groups. This is especially important given that New York's ethnic mix will continue to be churned, especially by way of diversity immigration and refugee flows from all parts of the globe.     

Chapter 10. Central American Survivors of Political Violence

Abstract

Despite compelling, well-documented findings on the levels of stress and trauma among Central American refugees, this group continues to be underserved. A host of issues contributes to this underservice, ranging from macro-level imposed obstacles, such as citizenship and health insurance as determining factors for accessing social and health services, to institutional factors that impede service utilization, such as an insufficient number of translators or a cumbersome and confusing bureaucracy. This chapter adopts a human rights framework as a strategy for working with groups of Central Americans who have experienced political violence. The ongoing effects of political violence on Central Americans, as they relate to mental and physical health problems, are reviewed and a case vignette is used to illustrate how political violence affects individuals and how macro-level forces and institutions create barriers to access and use of health care and social services. Treatment approaches for helping survivors of political violence in the context of a human rights framework are suggested.     

Participation in Micro-Finance Programmes and Women’s Mental Health in South Asia: A Modified Systematic Review

Micro-finance provides financial services to poor women from developing countries where cultural and social constraints limit their opportunities for economic advancement. Using Forbes’s process of conducting systematic review, 12 quantitative studies from South Asia reporting on the impact of micro-finance on women’s mental health outcomes were analysed. Overall, studies revealed that the duration and depth of involvement in micro-finance activities would make a difference in women’s mental health and not just receiving loans; however, rigorous programme evaluation is needed. Collaborative actions by micro-finance and health care practitioners to recognise women’s mental health needs and to strengthen measures to optimise the beneficial effects of micro-finance must be considered.     

The rise of risk assessment and risk management in the United Kingdom

This article examines the reform of the health care system in England in terms of the risk assessment and risk management. Three major health policies are examined, the Health of the Nation strategy, community care and the Patient's Charter. The article demonstrates that effective risk assessment and risk management is an important component of each initiative. The Health of the Nation strategy is based on epidemiological evidence on the nature of health risks and is linked to specific targets for the reduction of harm that require effective management of risks. Community care is a well established policy designed to provide long term and continuing support for vulnerable individuals in the community. With high profile incidents in the 1980s, there has been a greater emphasis on effective risk assessment and risk management, especially to protect the public. The Patient's Charter is designed to empower users of service.

Central to this strategy is informed consent. Effective empowerment depends of the provision of adequate information, especially on the risks of treatment. Although competent adults may formally be autonomous risk-taking decision-makers, their ability to assess risk and make decisions depends on having adequate information.     

Immigration to Portugal

Abstract

A peripheral West European country with a medium-sized population, Portugal experienced since the late 1990s a radical change in its migration trends, with growing and constant immigration flows. Not only the number of legal immigrants duplicated, but also the profile of immigrants changed and diversified. As a result, Portugal's public policies were challenged, and new social questions emerged. In particular, both public and private bodies have to deal with an increasing segmentation of the composition of immigration and of the labor market employing immigrants. Portugal still has not opted clearly for a model of immigration, and adaptation to these changes promises not to be easy, especially because the Portuguese society is simultaneously facing tensions deriving from its own     

Financial Stress and Depression Among African Refugees in the Southern United States: A Serial Multiple Mediation Analysis of Financial Self-Efficacy and Financial Anxiety

Abstract

As part of a larger community-based participatory research project exploring the postresettlement challenges of African refugees in the southern United States, our study investigated the phenomenon of financial stress and its relationship to mental health through a mediating chain of factors—financial self-efficacy and financial anxiety. Results revealed the mediating role of financial self-efficacy and financial anxiety on the relationship between financial stress and depressive symptoms. Findings provide discourses around financial stress and mental health in the migration context, critical to recognizing the unique experiences of African refugees and informing culturally responsive programs for financial inclusion and economic integration.     

Exploring a Model of HIV Prevention Using a Cognitive-Behavioral Skills-Building Framework with Black Immigrants

Abstract

This paper addresses the burgeoning Human Immunodeficiency Virus (HIV) crisis in the black community in the United States, particularly black women. A cognitive-behavioral skills-building HIV prevention intervention tailored to the realities of blacks in South Africa is presented as a model that may be modified and adapted for HIV prevention among blacks in the United States. This model of HIV prevention must view blacks as a heterogeneous group that includes African immigrants, and cognitive-behavioral skills-building HIV prevention interventions tailored to the realities of black women are needed for the prevention of heterosexually transmitted HIV infection. The implementation of HIV interventions within accessible sexually transmitted diseases (STD) testing and treatment programs will provide the combined clinical-behavioral approach that is missing in HIV prevention interventions among blacks in the United States.     

Social Justice Advocacy by and for Tibetan Immigrants

Abstract

Advocacy for immigrants empowers them to fight for social justice. For Tibetan immigrants this struggle for justice inside their home country has been part of their U.S. immigration experience. They have also been part of New York City immigrant coalitions that are advocating for basic services lost during the 1996 Welfare Reform. The need for more equable access to education is also addressed. Finally, the harshness of expedited removal of asylum seekers needs to be supplanted by procedures that safeguard human rights.     

A Framework for Visualizing the Process of Immigrant Absorption

ABSTRACT

This paper presents a schematic framework to assist in the visualization of the goals and processes involved in the absorption of immigrants. It is intended to help those engaged in working with immigrants to individualize persons and groups of immigrants in terms of various attitudes, values and behaviors, and to determine the goals, models and time-frames suitable for strengthening, and/or supporting and/or changing these aspects. The inter-relationship among some of the aspects is examined, and the paper includes examples of absorption, melting-pot and cultural-pluralism in various countries.     

Chapter 4. Concepts of Mental Health and Mental Illness in Older Hispanics

Abstract

The effect of cultural context in symptom expression and interpretation among older Hispanics, and how they experience psychological distress are not well-understood. We use the illness representation model to learn about older Puerto Ricans' and Dominicans' conceptions and causes of positive mental health, the causes of emotional problems, the conceptions and causes of depression and anxiety, the distinction between depression and anxiety, and the relationship between age and depression. Greater understanding of the meaning of symptoms and syndromes of depression and anxiety might help to define more culturally-sensitive mental health treatments and service delivery systems.